Provider Demographics
NPI:1144683137
Name:HAJIGHASEMI-OSSAREH, MOHAMMAD REZA (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:REZA
Last Name:HAJIGHASEMI-OSSAREH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:BRAVO
Other - Last Name:HAJIGHASEMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17360 BROOKHURST STREET
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:877-844-0012
Mailing Address - Fax:714-665-4680
Practice Address - Street 1:17360 BROOKHURST STREET
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:877-844-0012
Practice Address - Fax:714-665-4680
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012720742084N0400X
NC2021-027112084N0400X
AZ631482084N0400X
CAA1507192084N0400X
GA884882084N0400X
FLTPME12932084N0400X
KY556052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology